Healthcare Provider Details

I. General information

NPI: 1659425494
Provider Name (Legal Business Name): RICHARD L TYNER RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 WOODLAND SQUARE LOOP SE
LACEY WA
98503-1038
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-359-4860
  • Fax: 360-359-4861
Mailing address:
  • Phone: 206-764-0112
  • Fax: 206-764-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00004960
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: